Carcinoid and Neuroendocrine Tumor Program

Comprehensive Treatment and Innovative Therapies for Rare Cancers

The Carcinoid and Neuroendocrine Tumor Program at Cedars-Sinai Medical Center, under the leadership and Edward M. Wolin, MD (Medical Oncology) and Run Yu, MD (Endocrinology), Co-Directors, provides comprehensive multi-disciplinary care for patients with carcinoid and neuroendocrine tumors. Our team has access to the most current techniques for diagnosis and treatment and is one of a few such programs in the United States.

Neuroendocrine Tumors and Carcinoids

Neuroendocrine tumors are cancers of certain endocrine cells. In addition to growing and spreading like other cancers, they have the capability of producing hormones. Neuroendocrine tumors in adults commonly originate in the small intestine (carcinoid), pancreas, lung, colon, rectum, appendix and stomach, but many other primary sites are possible. Although most neuroendocrine tumors grow more slowly than many other cancers, there are some (eg. high grade, poorly- differentiated, or small cell cancer) that grow very fast. Some neuroendocrine tumors are named by the hormones that they produce, such as gastrinoma (gastrin), insulinoma (insulin), glucagonoma (glucagon), VIPoma (VIP), carcinoid (serotonin). Adrenal pheochromocytoma, paraganglioma, and medullary carcinoma of the thyroid are names of other rare neuroendocrine tumors.

Diagnosis

Most carcinoid and neuroendocrine tumors are very difficult to diagnose when they are small and not visible on routine types of imaging studies. However, advanced endoscopic procedures at Cedars-Sinai will usually find the hidden primary tumor causing intestinal obstruction or bleeding (double balloon push enteroscopy, endoscopic ultrasound of the pancreas, and wireless capsule endoscopy). Computed tomography scans (CT), advanced types of magnetic resonance imaging (MRI) scans and positron emission tomography (PET) scans, MIBG scan, octreotide scans are all used as needed to diagnosis primary tumors and metastases. Liver metastasis is very common from intestine and pancreatic primary neuroendocrine tumors.

Treatment

The Carcinoid and Neuroendocrine Tumor Program provides comprehensive treatment for all types of neuroendocrine tumors. At Cedars-Sinai, we have access to the most sophisticated types of laparoscopic and minimally invasive surgery for primary tumors, liver metastases; Specialized interventional radiology is available for Y-90 radio-embolization, hepatic artery chemo-embolization, radio frequency and microwave ablation, and other specialized techniques for treating liver metastases. For carcinoid and neuroendocrine tumors, we have assess to treatments including hormone therapies (somatostatin analogs) biotherapy, immunotherapy, many types of targeted biologic agents, and peptide receptor radiotherapy using Lu-177. In addition, we utilize the latest endocrine techniques for managing hormone production syndromes from these tumors. The Program's patients also have access to other Cedars-Sinai services, including the Samuel Oschin Comprehensive Cancer Institute, Endocrinology Services, Liver and Kidney Diseases and Transplantation, and S. Mark Taper Foundation Imaging Center.

Research

The Carcinoid and Neuroendocrine Tumor Program at Cedars-Sinai has one of the largest and most comprehensive clinical research programs in the country devoted to these rare diseases, bringing cutting-edge new treatments to our patients. Among the treatments being actively studied are the new somatostatin analogs pasireotide and lanreotide, and multiple oral targeted biological agents which prevent cancer cells from multiplying, without the toxicity of traditional chemotherapy. These include many types of m-TOR inhibitors including everolimus and TORC-1+TORC-2 inhibitors,and peptide receptor radiotherapy PRRT. We also have clinical trials using immune stimulants and anti-angiogenic agents.

Cedars-Sinai is actively involved in numerous neuroendocrine tumor-related laboratory research studies, some of which are funded by the National Institutes of Health (NIH). Researchers at the Carcinoid and Neuroendocrine Tumor Program are currently investigating the molecular genesis of carcinoid and neuroendocrine tumors, as well as innovative, subcellular therapy. For example, through translational research,we have discovered a novel disease involving pancreatic neuroendocrine tumor. An animal model of pancreatic neuroendocrine tumor has been identified here and is used by our researchers to study pathogenesis and treatment of pancreatic neuroendocrine tumors. Other research conducted at Cedars-Sinai has helped identify some genetic mechanisms involved in tumor growth and resistance to treatment.

Physician Referral

The Cedars-Sinai's Carcinoid and Neuroendocrine Tumor Program works closely with referring physicians to coordinate management, typically remaining in close touch by letter and phone. For new patient referrals, please direct your calls to the Samuel Oschin Comprehensive Cancer Institute at (310) 423-0709.